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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />[/]eter Release
<br />Rouqh 1 zoltgfr 4\"\ai,,>)
<br />Service lt4eter
<br />FINAL lK7-/"6rvotW
<br />Notes, Remarks, Etc I
<br />OWNI]R NUII,DER DET-C RA'TON
<br />I hcrchy arfim u er p.nrlry ut Frjury rhar I rm.rcnlpr rft,n rhc conxmtoN l-i.ctrs L.s aor rh.Iollo$ins r.r$n (sd70:11.5
<br />Bu\incis rnd Pft,rcssion Codc) Any Ciiy or Counly which rcquir$ u plnnir t' .a,ndtu.r. rlr$, nnptuvc. dcnFlish ot rcPln lny
<br />\lrucrurc. prn'r I. ils hsulncc. al\o rcqutcs rhc lpplicor for such l,.nnir ro fiL. srlncd $ircnEnr rhor hcot shc n liccnscd nuau r
<br />ro ihc pmuiri.ns oi rhc Conlflcrois l-i.cnscd tiN (Chtnlcr ,- Conrmcnci'rE wirh Sccrion 7fin oa Divisiotr I ol rhc llusi,rcs\ trnd
<br />Profc$ion\Codc) nrriar hcor\hc hcrctu|n rhcrcrronand rh.brsii rd rh. rlLscd cxcnrfli{,n. Any vn'hri{'n ol scdio T0:ll5htrny
<br />trmli.a ' rdrrfidf \uhjdsrhc aprli.0trr b a.ivilpc ,lryorn.r trhrc lMn fivc hundrcd dollln (S5(D)
<br />-l-
<br />ar o*mr oi lhe pop.ny. (tr m, c'npk,$c\ wirh wascq rhcn $b .onrncnqfion. will do rhc wort ei rhc {tuh ic ior
<br />inrd{kd.roffcrcdfor$lc(Se?(ll4.AusincssaMProfcssionsCqic:Thc(inrmtnrLic.nscL0wdocsnolalPlybtrnowmrol
<br />rhc rDp.ny *ho h{ilds or irri(*B rh.d{. ,ixi who dds ssh so* himscllor h.rs!fo' ihduBh hh o. hcr n*n cmployccs.
<br />providcd rh,l ch nlll)rolcmnls m ml i cfrlcd or orlcrcd for {l. lt hor*o, rIf,l)uildinSor in{rovcmnl hsldwirhin''nc ttr
<br />olcoll{'btion- rtr Owncr Blild$ will hak rhd h,J.n of pmvi'rs rhr hc or sh. d i] mt build or in]Ilrovc lhe Is)pciy ror rtt ,,uqr{ of
<br />l. \ownsorrh.pn,!c y. n.xctu\nrly.onricrirerirhlic.nscdco rcro6 t' c.n(tucr rhc tticcr (sLt 71),1,1. Btr\ir'!\!
<br />.nd hrtcssion (odc: lh. Conirr.roir l-iccnsc L.rw docL noi nptlyk) rd.(hcr I pfl,pcrrrsln, buil or n ptu\cs rlrrcor
<br />rid sho Lo m.rl f$ \uch pmicl s wilh r Conlmcro(, li(trnal fumu n,rh.Coihacttr\ l-{ctrsc l-rwl
<br />I rn,.x.nrl undcrSr.rtr,
<br />]}I}8.IEIIS:.CAUfjNSAION
<br />DECI.AAAIIAN
<br />I lrcrchyrllirmtr crrmlrrof NrJrtryoncof rl{lnlkrwir[d..ldr.Lotrs
<br />! l[vc anl will nrinrnin . Ccnifrcolc of Conenl ro Seli lnrurc ntr *brkcF .onD.nsd ion. $ povidc{ for by Sel i{,n :r7([ or rhc
<br />tlhnCod., r{rrhcp.raoirn.nccoflhcwo.t for *hkh rhc renril h nsucn.
<br />I havc.ndwill minhin workc.i conFn\arion insnra.cc- ar rcquncd hyssrion:lT0Oollhc Llbor Codc. r{rrhc p.ilornrNcol
<br />lhcwortiorRhichlhhrcrnrilishsucn.Myworkqicomncn\lri{,ninsur.c.aricrandFli.ynuflrherirc:
<br />Poli.y Numbcr:-Erpircsr
<br />-
<br />I ccniryrhrr inrh. puro'nu,rc oflh.work nx wni.hthhlcrnrit i\ isucd.I shlll nor .'nploy rtry l.R inrnymnncr
<br />s, ar lo tEcorx su6jar r{, rhc $o,kc.i conrr.on ii,n h$s ot C{liftmir, ,trd .8rc. rhal i l l stFuld hecom ubj(r fu rhc
<br />wolkcn.omFns.tionEovisionsolScrnr.lT0Onllnct,txtrC{nl..l\hnll,rodhBirhcoardyBilhrhoscPmltions
<br />h ntu hrndrcd rhou\r d dollxr\ rslUl.(fi)). h nd fidr n' rlr co\l oi..mpensarhn. dsnBgcs ,s provdcd lor thc
<br />S..ri,r.rlr76 olrhc Irfitr Codc. n rrc{ r d
<br />'",., 7,=/t t'
<br />t) j,,\RAt'roN
<br />I h&hr,flnnr uM.r lxnrlry oiNrjury I rm lietrql undcr [ovi\i(r ofCh4rcr 9(c.nnmncifl8 *ilh Sslir 7(fi)) ofDivisn{ ]
<br />ol rhc lnni,rsr d Pn,lc\\i(u\ Codc.I y lrctr{ i\ ir tilllnr.c ,xtc,ri.r
<br />-S>=/ J ,i
<br />"'" ?fi--/ t d'
<br />I tcrel,y amrm rndcr pcnalryorFrjuryth de ir I mnsru.riob hnding ag.'Ey lbr lhc lsfomm. or rtu sort for which thh ,'smi n
<br />issucd (S.c. 109?. Civ C.).
<br />AIIUCANLIIECLAAAIII]!
<br />I hca$y rfrmr undcr p.n.lty olFrjury orc of rhc followinr d(l,rdionq:
<br />DcmhionPc nirsAsbcsosNorincarion FcdcrDl Rc8ularion\llirlc40.Pan6)
<br />Rcqutcd bltcr of Nolifi calion
<br />rlr lid.'x rrguhr(rA'r!x'dtris n:h.{i^'( rtrf L r. f ,i rt,t,li rh. n, Ln t) or,(r
<br />Ihlkrc this atdtarion 0d srltc thur rhc 0totr nrforrorion isco^-'t Irrrek,c.nDlyqilhollCnrand(i,tnry
<br />srarcbqsrcl i,rs lo buildins .onslruclion. si herchy N'lxtri?. rcnrcscnrdrivcs otrhis Cirynnd Colnryt, c.rcr upon rhc
<br />,\^FT2
<br />*Nl.-7'>4 /-9t{7^,'Q zq '1
<br />,,?f e/{=
<br />txnd.rs Addr.s
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